Intravenous Thrombolysis Administration 3–4.5 h After Acute Ischemic Stroke: A Retrospective, Multicenter Study

Abstract

Background and Objectives: Intravenous recombinant tissue plasminogen activator (rt-PA) has been approved for acute ischemic stroke (AIS) within 3 h after onset and the treatment was then extended to 4.5 h. However, the Food and Drug Administration did not approve the indication in the expanded time window. This retrospective, matched cohort study aims to investigate the effectiveness and safety of rt-PA in AIS at 3–4.5 h after onset.Materials and Methods: The treatment group included AIS patients receiving rt-PA at 3–4.5 h after onset, otherwise complying with the regulation, in the stroke registries in 16 hospitals between 2008 and 2017. The control group included age- and sex-matched patients not receiving intravenous thrombolysis from the same registries, excluding those with contraindications. The primary outcome was modified Rankin Scale (mRS) 0–1 at day 90. The safety outcomes were any intracerebral hemorrhage (ICH), early neurological deterioration and 3-month mortality.Results: Each group had 374 patients. There were 34.0% of patients with 3-month mRS 0-1 in the treatment group vs. 22.7% in the control group with an odds ratio of 1.75 (95% confidence intervals, 1.27 to 2.42, P = 0.001). There was no difference in symptomatic ICH, early neurological deterioration and 3-month mortality rates between two groups. The 3-month mRS and symptomatic ICH did not differ significantly in patients receiving standard dose or low dose of rt-PA.Conclusions: Our results support the prescription of rt-PA in AIS patients 3–4.5 h after onset as an effective and tolerable treatment in their functional recovery.

Efficacy and safety of scalp acupuncture in improving neurological dysfunction after ischemic stroke

“…Although timely thrombolytic therapy could reduce nerve cell death and injury to a certain extent, the limited time window and strict requirements for thrombolysis have led to the lower clinical utilization of thrombolytic therapy. [ 4 , 5 ] Moreover, there are still 2/3 patients have different degrees of disability after successful intravenous thrombolysis, [ 6 ] which makes it important to improve neurological dysfunction recovery after ischemic stroke.…”

Neuroserpin extends the time window of tPA thrombolysis in a rat model of middle cerebral artery occlusion

“…[ 1 ] ACI patients with early recanalization have fewer damaged neurons, as well as better prognosis. [ 2 ] In clinical practice, thrombolysis is one of the main strategies to treat ACI, especially in the emergency management. [ 2 ]…”

“…[ 2 ] In clinical practice, thrombolysis is one of the main strategies to treat ACI, especially in the emergency management. [ 2 ]…”

“…Importantly, tPA treatment has a narrow treatment time window, and thrombolysis beyond the time window increases the risk of intracranial hemorrhage. [ 2 ] Therefore, expanding the treatment time window of tPA is of great significance.…”

Effect of Huoxiang Zhengqi Pill on Early Neurological Deterioration in Patients with Acute Ischemic Stroke Undergoing Recanalization Therapy and Predictive Effect of Essen Score

“…However, only a small number of patients were treated within the time window, and some patients still experienced neurologic deterioration after thrombolysis, which is called early neurologic deterioration (END) [ 2 ]. END is one of the most common complications of AIS, affecting about a third of ischemic stroke patients and increasing the risk of adverse functional outcomes and death [ 3 – 5 ]. Therefore, it is necessary to investigate the likely impact on the prediction and treatment strategies for END and to provide a novel strategy for the diagnosis and treatment of AIS.…”